Treating Primary Progressive Aphasia with AAC

Augmentative and Alternative Communication Treatment for Persons With Primary Progressive Aphasia

Melanie Fried-Oken

Summary: 

With increasing frequency, speech-language pathologists are considering the use of AAC for people with Primary Progressive Aphasia (PPA). Because it is a relatively new diagnosis and does not fit precisely within the framework of other types of aphasia, guidance is often needed about when and how to introduce AAC.

The author outlines two primary treatment challenges when using AAC with a person with PPA: how to provide a visual vocabulary to enable the person to participate in daily life activities as language declines, and how to modify the environment to support communication.

Based on these considerations, there are generally three goals to address when starting to use AAC with a person with PPA. First, to try to compensate for language loss as skills deteriorate. This is in contrast to someone with another type of aphasia, where the goal is likely to improve language skills. Second, to introduce AAC as soon as possible, so that the person can learn to use the tools available. The last goal is to involve communication partners in AAC device training, as they will become increasingly important as verbal skills decline.

The author proposes a five-stage treatment framework based on level of impairment. As the levels progress, the patient is likely to rely more heavily on AAC, and communication partner support becomes crucial. It is also noted that in the final stage of progression, the AAC tool may need to be simplified to meet the user’s changing needs. Any system chosen should rely heavily on images, as someone with PPA will largely use their visual skills in later stages of progression.

When using a high-tech device, it’s critical to address the patient’s communication goals and use tools to determine what is most functional and meaningful for the user. Using the device to store and share autobiographical memories can be very rewarding for many. As always, each patient must be evaluated for clinical appropriateness of high-tech AAC.

Incorporating the Research into Clinical Practice with Lingraphica

Lingraphica AAC devices feature multi-modal icons with pictures and realistic drawings that are a great starting point for someone with PPA. When using an AAC device with someone with PPA, it’s critical to create a device that will meet their needs immediately (depending on impairment progression), while being easy to modify as verbal skills decline.

One recommendation when programming a device for a person with PPA is to make sure the most important and meaningful vocabulary is at the top of the page, and within 1-2 layers of the home page. Additional vocabulary can be stored farther down the page or deeper within the system. By doing this, it is easy to simplify the device if needed as the impairment becomes more severe, without needing to change the organization that the user has already learned.

Another best practice when working with someone with PPA is using the voice recording feature. If you start early with AAC, the user has the opportunity to record messages in their own voice while they still have some verbal skills. This can be especially meaningful for family members’ names, phrases like “I love you,” and any personal “catchphrases.”

As stated in the article, two key components are to start early and involve communication partners as much as possible. This enables both the user and the communication partner to learn the AAC system while communication skills are still at a higher level. As the impairment progresses, the communication partner should be prepared to provide additional assistance supporting the use of the device.

To learn how more about how AAC devices can help with PPA, schedule a free consultation.